Uterine Artery Doppler Indices Research Articles

Doppler indices of the equine fetal carotid artery throughout gestation

Assessment of pregnancy viability in the equine patient is currently based on gestational profiles of limited prognostic value. In recent years Doppler technology has been applied to uterine and umbilical arteries of pregnant mares to monitor fetal responsive haemodynamics, suggestive of compromise. To date, uterine artery Doppler indices failed to provide sufficient evidence of pregnancy viability and the umbilical cord of the equine fetus is inconsistently visualized past 250 days gestation.The objectives of this study were to: i) evaluate intracranial blood flow impedance by Doppler examination of the fetal carotid artery and ii) establish reference values for healthy, uncomplicated pregnancies. The middle cerebral artery (MCA), a branch of the carotid artery, is commonly employed to assess intracranial hemodynamics in the human fetus, exhibiting high resistance to circulation to the fetal brain in uncomplicated pregnancies. For the purpose of this study, 12 pregnant mares were examined at 2–3 weeks interval by B mode and Doppler ultrasonography until delivery and a novel technique was developed for Doppler evaluation of the carotid artery in the equine fetus, in order to provide objective evidence of the hemodynamic status of the equine fetus. Additional biophysical and biochemical parameters were collected to demonstrate appropriate pregnancy development. In this study Doppler waveform analysis of fetal intracranial vasculature demonstrated an elevated blood flow impedance, showing a significant correlation of carotid Doppler indices with gestational age. Results were comparable to human fetal trends for the middle cerebral artery (MCA) from mid gestation to term. Biochemical data showed expected patterns of uncomplicated pregnancies.

Implementation of routine first trimester combined screening for pre-eclampsia: a clinical effectiveness study.

Evaluate clinical effectiveness of the first trimester combined (FMF) pre-eclampsia screening programme when implemented in a public healthcare setting. Retrospective cohort study. London tertiary hospital from January 2017 to March 2019. 7720 women screened for pre-eclampsia according to National Institute for Health and Care Excellence (NICE) risk-based guidance and 4841 by the Fetal Medical Foundation (FMF) algorithm which combined maternal risk factors, blood pressure, PAPP-A and uterine artery Doppler indices in the first trimester. High risk was defined by standard NICE criteria in the pre-intervention cohort (prescribed 75mg aspirin) or a risk of ≥1:50 for preterm pre-eclampsia from the FMF algorithm in the post-intervention cohort (prescribed 150mg aspirin). Screening effectiveness, rates of pre-eclampsia. The FMF screening programme resulted in a significant reduction in the screen-positive rate (16.1 versus 8.2%, odds ratio [OR] 0.50, 95% confidence interval [CI] 0.41-0.53) with a concurrent increase in targeted aspirin use in women classified as high risk for pre-eclampsia (28.9 versus 99.0%, OR 241.6, 95% CI 89.6-652.0). Screening indices were uniformly improved for the FMF algorithm with receiver operating characteristic (ROC) analysis demonstrating excellent discrimination for preterm pre-eclampsia (area under the curve [AUC]=0.846, 95% CI 0.778-0.915, P value<.001). Interrupted time series analysis showed that the FMF screening programme resulted in a significant 21-month relative effect reduction of 80% (P=.025) and 89% (P=.017), for preterm and early pre-eclampsia, respectively. First trimester combined screening for pre-eclampsia is both feasible and effective in a public healthcare setting. Such an approach results in a two-fold de-escalation of risk, doubling of pre-eclampsia detection, near total physician compliance of aspirin use and a significant reduction in the prevalence of preterm pre-eclampsia. Implementation of 1st trimester combined pre-eclampsia screening effectively reduces prevalence of the disorder.

Effect of previous cesarean sections on second-trimester uterine artery Doppler.

In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices. This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy-three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices. The mean uterine artery pulsatility index (PI) MoM value was 1.18 ± 0.40 in the study group and 1.07 ± 0.35 in the control group (P = 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P = 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 ± 1.3 vs. 39 ± 1.0, P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P = 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher. The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.

Evidence for uteroplacental malperfusion in fetuses with major congenital heart defects.

AimsFetuses affected by congenital heart defects (CHD) are considered to be at increased risk of fetal growth restriction and intrauterine demise. Whether these risks are a direct consequence of fetal CHD or a result of associated uteroplacental dysfunction is not evident from the data of recent studies. The aim of this study was to investigate the prevalence of uteroplacental dysfunction reflected by abnormal uterine artery Doppler indices and reduced fetal growth in CHD pregnancies.MethodsThis is a retrospective case-control study including singleton pregnancies referred for detailed fetal cardiac assessment subsequently diagnosed with or without CHD. Mid-trimester uterine artery Doppler assessment at 20–24 weeks as well as third trimester fetal biometry and arterial Doppler pulsatility indices (PI) were performed. All fetal biometry were converted into centiles and Doppler values to multiples of median (MoM) to adjust for physiological changes with gestation.ResultsThe study included 811 pregnancies including 153 cases where the fetus was diagnosed with CHD. Mid-pregnancy uterine artery PI was significantly higher in women with fetal CHD compared to controls (0.90MoM vs 0.83MoM; p = 0.006). In the third trimester, median centiles for fetal head circumference (45.4 vs 57.07; p<0.001), abdominal circumference (51.17 vs 55.71; p = 0.014), estimated fetal weight (33.6 vs 56.7; p<0.001) and cerebroplacental ratio (CPR: 0.84MoM vs 0.95MoM; p<0.001) were significantly lower in fetuses with CHD compared to controls. The percentage of small for gestational age births <10th centile (24.0% vs 10.7%; <0.001) and low CPR <0.6MoM (11.7% vs 2.5%; p<0.001) were significantly higher in the fetal CHD cohort.ConclusionsMid-pregnancy uterine artery resistance is increased and subsequent fetal biometry reduced in pregnancies with CHD fetuses. These findings suggest that fetal CHD are associated with uteroplacental dysfunction, secondary to impaired maternal uteroplacental perfusion resulting in relative fetal hypoxaemia and reduced fetal growth.

Assessment of the efficacy of uterine artery Doppler in predicting the response to Mefenamic acid during treatment of women having IUCD associated menorrhagia

Background: Bleeding with IUCDs is considered iatrogenic dysfunctional uterine bleeding. The bleeding associated with IUCD use may either occur during menstruation (heavy and/or prolonged) or in the form of intermenstrual bleeding and spotting.Patients and Methods:This study was carried out on 156 women attended the family planning out-patient clinic in the Obstetrics and Gynecology Department, Ain-Shams University Hospitals, during the period from May 2017 to May 2018. Patients were divided according to the response to treatment into two groups: Group (I): Responders to treatment with Mefenamic acid and Group (II): Non-responders to treatment with Mefenamic acid. Response to treatment was evaluated according to: Pictorial blood loss assessment chart.Results: Interpretation of the results of this work showed that uterine artery mean value of the PI of the women who responded to treatment with Mefenamic acid (group I) (1.54±0.42) were significantly higher than mean value of PI of women who didn’t respond to treatment with Mefenamic acid (group II) (0.96±0.28), also showed that uterine artery mean value of the RI of the who responded to treatment with Mefenamic acid (group I) (1.01±0.25) were significantly higher than mean values of RI of women who didn’t respond to treatment with Mefenamic acid (group II) (0.71±0.21). Doppler indices showed that pulsatility index ≥ 1.27 had moderate sensitivity (75.3%) and NPV (75.3%) but high specificity (90.1%) and PPV (90.1%) in prediction of responders. Resistive index ≥ 0.93 had low sensitivity (69.4%) and NPV (70.8%) but moderate specificity (88.7%) and PPV (88.1%) in prediction of responders.Conclusion:There is a strong relationship between uterine artery Doppler indices and prediction of response to Mefenamic acid.

The role of clinical and laboratory tests along with uterine artery Doppler indices in the prediction of pre-eclampsia and pregnancy outcome in Egypt

Background and aim As the ideal test to predict pregnancy-induced hypertension and preeclampsia should be inexpensive, reproducible, easy to do early in pregnancy, and noninvasive and have high sensitivity, the aim of this study was to evaluate clinical parameters, laboratory tests, and uterine artery doppler indices in prediction of preeclampsia and pregnancy outcome.Patients and methods This study was carried out in the antenatal care clinic of Obstetrics and Gynecology Department of Al Azhar University Hospital. The study included 177 pregnant women booked for antenatal care before 18 weeks of gestation, who were considered to be at increased risk of developing preeclampsia.Results Doppler flow velocimetry of the uterine artery at 18–20 and 22–24 weeks of gestation represents a useful predictive test in high-risk pregnancy and in predicting preeclampsia, when used as a single test. Microalbuminuria between 24 and 34 weeks of gestation, in the first morning urine specimen, is a good predictor for the subsequent development of preeclampsia.Conclusion When three tests were combined to test their ability to predict preeclampsia, the best triple tests were microalbuminuria, uterine artery doppler flow velocimetry study at 24–26 weeks of gestation, and mean platelet volume, which gave the highest value when κ test of agreement was used.

The predictive value of 11-14 week uterine artery Doppler indices for hypertensive pregnancy complications

Introduction. Hypertensive complications of pregnancy can often lead to serious, even life-threatening situations for the mother and fetus. First-trimester uterine artery Doppler can be a predictive tool for such complications. Materials and method. At the Department of Obstetrics and Gynecology of the Arad County Emergency Clinical Hospital, we examined 305 pregnant patients, from 11 weeks to 13 weeks+6 days gestational age, by ultrasound, both as inpatients and outpatients, and we have assessed the evolution of their pregnancy. Results. There were 21 patients with hypertensive pregnancy complications (6.89%) and 284 patients with normal outcome (93.11%). Three patients had pregnancy-induced hypertension (0.98%), and 18 had preeclampsia (PE; 5.9%), with 12 cases of mild PE (3.95%) and six cases of severe PE (1.97%). The sensitivity for uterine artery PI above the 95th percentile, for uterine artery RI above the 95th percentile, and for uterine artery PI/RI above the 95th percentile was 0%, 0-33.33% and 0%, respectively. The specificity was 94.72-95.03%, 94.98-95.42% and 94.98-95.03%, respectively. The positive predictive value was 0%, 0-13.33% and 0%, respectively. The negative predictive value was 92.76-98.97%, 93.45-99.31% and 92.76-98.97%, respectively. Odds ratios were 0.453-3.966, 1.147-10.286 and 0.453-3.966, respectively. Conclusions. Uterine artery Doppler indices above the 95th percentile during the 11-14 week gestational age offers low to medium detection rates, the best index being the resistivity index.

Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters.

ObjectiveTo provide a standardized protocol for the measurement of cervical strain elastography, present its reproducibility, and analyze baseline clinical factors affecting the measurement of elastographic parameters.MethodsThis study was performed by the Korean Research Group of Cervical Elastography. We enrolled pregnant women according to our study protocol. After measuring the cervical length, elastography was performed using the E-Cervix™ quantification tool to measure the strain of the cervix using intrinsic compression. We evaluated 5 elastographic parameters, namely, the strain of the internal os of the cervix (IOS), strain of the external os of the cervix (EOS), ratio of the strain of IOS and EOS, elasticity contrast index, and hardness ratio. For baseline clinical factors, we examined the maternal body mass index, blood pressure, heart rate, uterine artery Doppler indices, and fetal presentation.ResultsWe established a specific protocol for the measurement of cervical elastography using the E cervix program. For all elastographic parameters, the intra-observer intraclass correlation coefficient (ICC) ranged from 0.633 to 0.723 for single measures and from 0.838 to 0.887 for average measures, and the inter-observer ICC ranged from 0.814 to 0.977 for single measures and from 0.901 to 0.988 for average measures. Regression analysis showed that the measurement of the elastographic parameter was not affected by baseline clinical factors.ConclusionWe present a standardized protocol for the measurement of cervical elastography using intrinsic compression. According to this protocol, reproducibility was acceptable and the measurement of elastographic parameters was not affected by the baseline clinical factors studied.

Uterine artery pulsatility index for the prediction of obstetrical complications in preterm prelabor rupture of membranes

Introduction Abnormal uterine artery Doppler studies have been associated with an increased risk of preeclampsia, fetal growth restriction (FGR), placental abruption, and fetal demise. These obstetrical complications can affect pregnancies with preterm prelabor rupture of membranes (PPROM). Therefore, our objective was to assess the prediction accuracy of the uterine artery pulsatility index (UtAPI) to detect these complications in pregnancies with PPROM. Materials and methods This was a prospective study of pregnancies complicated by PPROM from October 2015 to May 2018. We included mothers aged 13–46 years old with singleton pregnancies from 23 to 36 + 6 weeks with PPROM. Those without UtAPI measurements and complex fetal anomalies were excluded. Our primary outcome was a composite of obstetrical complications, defined as having one or more of the following: gestational hypertension or preeclampsia, placenta abruption, FGR, or fetal demise. The UtAPI was obtained at the time of enrollment. Logistic regression models with receiver operating curves were used to determine the predictive value of the UtAPI for obstetrical complications. A p value of <.05 was considered significant. Results A total of 103 patients met inclusion criteria, of those 37 (36%) developed an obstetrical complication (FGR = 22 (21.5%); preeclampsia or gestational hypertension = 9 (9%); placental abruption = 8 (8%); fetal demise = 1 (1%)). Six mothers had more than one complication. The UtAPI was not a statistically significant predictor of a composite of obstetrical complications (AUC = 0.61; p = .07) or for any of the individual complications studied. Conclusions The UtAPI appears to have limited clinical value for the prediction of obstetrical complications previously associated with abnormal uterine artery Doppler indices in pregnancies with PPROM. Larger and more diverse studies are needed to corroborate our findings. Brief rationale An accurate prediction for adverse outcomes in patients with PPROM may help identify those that may benefit from increased surveillance protocols.

Sildenafil citrate adjuvant treatment in women with polycystic ovary syndrome following clomiphene failure: A randomized controlled trial

Objective: The widespread classic PCOS treatment algorithm, consisting of 6-12 cycles of clomiphene followed by shifting to gonadotropins in case of failure to conceive, doesn’t really address the cause of failure to conceive despite documented ovulation. Sildenafil citrate improves uterine blood flow, enhances endometrial development and modulates endometrial receptivity. Hence, this study monitored the ovarian response, endometrial development and subendometrial Doppler changes in PCOS women with previous clomiphene citrate failure following the use of adjuvant sildenafil citrate instead of shifting to gonadotropins. Patients and Methods: A double-blinded randomized controlled trial was conducted in Ain-Shams University Women’s Hospital on 850 PCOS women with clomiphene failure. Those were randomized to clomiphene therapy, either with adjuvant placebo or sildenafil citrate (25 mg orally 6 hourly), starting from the 6th day till the end of the cycle.Folliculometry, every other day, started on the 10th day of the cycle. When ≥1 follicle reached a size ≥18mm, transvaginal ultrasound assessment of the endometrium and uterine/subendometrial Doppler was done. The resulting pregnancy rates were recorded. Results: The sildenafil group developed higher endometrial thickness (10.6±1.3 versus 9.4±1.5; p<0.001), a higher percentage of women with trilaminar endometrium (78.35% versus 59.76%; p<0.001) was found while the lower percentage was found with subendometrial and uterine artery Doppler indices (p<0.001 for all). It also developed higher pregnancy rates (43.7% versus 34.5%, p=0.006; NNT=10.8, 95% CI: 6.36 – 37.84).Conclusion: Sildenafil adjuvant therapy significantly increased pregnancy rates, improved endometrial development in terms of endometrial thickness and pattern as well as uterine and subendometrial blood flow.

Doppler Ultrasound Screening of the Uterine Arteries as a Predictor for Early Miscarriage

Objectives: So far, there is no concrete consensus on using uterine Doppler measurements for predicting the adverse outcomes in the early stages of pregnancy between 6-14 weeks. Hence, the current study was planned to investigate the role of uterine artery Doppler in predicting the miscarriage in early pregnancy and to evaluate whether uterine artery Doppler indices abnormality is associated with a complicated pregnancy and adverse outcomes. Materials and Methods: The present cross-sectional prospective study estimated the uterine artery Doppler of right and left uterine arteries and the mean of pulsatility index (PI), resistance index (RI), and systolic/diastolic (SD) ratio was obtained for each patient. The gestational age, at which the Doppler study was performed, was 6-14 weeks for all groups. Finally, the groups of normal and threatened miscarriage were followed up for the outcome up to 20 weeks of gestation. Results: There was a significant difference in the means of PI, RI, and S/D ratio among the three groups. However, PI was the only parameter which was significantly associated with the outcome of pregnancy. In addition, the cut-off value for PI was 2.64 at 91% sensitivity and 81% specificity for predicting miscarriage. Conclusions: In general, uterine artery Doppler should be introduced as the routine screening test for identifying the women who could have an adverse pregnancy outcome for its effective management.

Antepartum and postpartum uterine artery impedance in women with pre-eclampsia: a case control study

This is a cohort study which included 100 cases with pre-eclampsia (PE) and 100 controls, done to compare the antepartum and postpartum uterine artery (UtA) Doppler velocimetry between them. UtA PI and RI were measured before and within 48–72 h after delivery. There was a highly significant difference between the cases and controls, regarding the UtA RI (0.70 ± 0.10 and 0.72 ± 0.10, versus 0.59 ± 0.12 and 0.60 ± 0.11) and PI (1.41 ± 0.89 and 1.45 ± 0.90 versus 0.85 ± 0.30 and 0.90 ± 0.34) measured at the antepartum and postpartum periods, respectively. Age and gestational age were significantly related to the postpartum and changes in the UtA PI. The gestational age was also correlated to UtA RI changes. Both the antepartum and postpartum mean blood pressure were correlated with postpartum UtA RI and PI and PI changes after delivery. We concluded that uterine artery Doppler indices changes are more common in women with PE, than in normotensive women with significant correlations with age and gestational age. Impact statement What is already known on this subject? After delivery, the haemodynamic changes that occurred with pregnancy reverse. Both the heart rate and the cardiac output decreased to reach the non-pregnant state. Impedance to flow in the uterine artery rises as the nutritional needs are decreased abruptly. What do the results of this study add? Both the antepartum and postpartum measurement of uterine artery Doppler indices is significantly higher in women with PE when compared to control women. The persistent uterine artery impedance is a result of inadequate trophoblastic invasion within the basal part of the decidua basalis and myometrium or persistently increased maternal vascular tone. What are the implications of these findings for clinical practice and/or further research? The uterine artery Doppler parameters return to the non-pregnant values in normal pregnancies. Knowing such information may help in understanding the haemodynamics of the uterine vasculature during puerperium in hypertensive patients.

Role Of Uterine Artery Doppler For Prediction Of Fetal Outcome In Preeclamptic Patients

Objective: The aim of this prospective observational study is to assess the accuracy of Doppler indices of uterine artery during the third trimester in predicting poor fetal outcome in women with preeclampsia. Methods: Study design: Cohort observational study among women with preeclampsia. Study setting: One hundred cases who were at 32 to 40 weeks of gestation with preeclampsia(from March 2017 to March 2018) attended antenatal clinic and emergency room at obstetrics and gynecology department, faculty of medicine, Sohag University Hospital. Ultrasound was performed at the fetal care unit at Sohag University Hospital. Results: This observational cross-sectional study was designed to assess Doppler indices of uterine artery as predictor of neonatal outcomes among women with preeclampsia.A total of 100 pregnant women with preeclampsia were recruited in the study Conclusion: We recommend adding mean uterine artery Doppler indices to routine antepartum fetal surveillance from 32 weeks gestation for women with preeclampsia as there is a strong correlation between it and poor neonatal outcomes.

Relationships of serum placental growth factor and soluble fms-like tyrosine kinase-1 with fetal and uterine artery Doppler indices in pre-eclampsia.

To compare serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) concentrations among women with pre-eclampsia and healthy control women and to evaluate the associations of serum PlGF and sFlt-1 with fetal and uterine artery Doppler indices in pre-eclampsia. A prospective cross-sectional study of 33 women with pre-eclampsia and 33 normotensive pregnant women attending a university hospital in China between January and November 2014. Serum PlGF and sFlt-1 were assayed by enzyme linked immunosorbent assays. Doppler indices of the uterine artery, umbilical artery, fetal middle cerebral artery, and ductus venosus were measured. The pulsatility index of the uterine artery was negatively correlated with PlGF (r, -0.487; P=0.004) and positively correlated with sFlt-1 (r, 0.420; P=0.015). Gestational age at birth was positively correlated with PlGF (r, 0.601, P<0.001) and negatively correlated with sFlt-1 (r, -0.568; P=0.001). Birth weight was positively correlated with PlGF (r, 0.555; P=0.001) and negatively correlated with sFlt-1 (r, -0.552; P=0.001). Apgar score was negatively correlated with sFlt-1 (r, -0.427; P=0.017). Lower PlGF and higher sFlt-1 levels in maternal serum were significantly associated with increased uterine arterial impedance in pre-eclampsia.

The Effect of Antenatal Vaginal Progesterone Administration on Uterine, Umbilical, and Fetal Middle Cerebral Artery Doppler Flow: A Cohort Study.

This study aimed to evaluate the effect of vaginal progesterone (P) administration during the second and third trimesters of pregnancy on Doppler velocimetry of uterine, umbilical, and middle cerebral vessels. A prospective cohort study conducted on 80 women at risk for preterm labor. Uterine artery, umbilical artery, and middle cerebral artery (MCA) Doppler indices were measured before and after 1 week of administration of 200 mg twice daily vaginal P. The primary outcome parameter was the change of MCA pulsatility index (PI) after P administration. Secondary outcomes included changes in uterine artery and umbilical artery Doppler measurement. There was no significant changes of umbilical artery resistance index (RI) (0.69 ± 0.049 vs. 0.68 ± 0.041), umbilical artery PI (1.14 ± 0.118 vs. 1.11 ± 0.116), uterine artery RI (0.66 ± 0.12 vs. 0.66 ± 0.107), uterine artery PI (1.00 ± 0.26 vs. 1.016 ± 0.24), and MCA PI (1.27 ± 0.18 vs. 1.26 ± 0.23) measurements before and after 1 week of P administration, respectively. Administration of vaginal P has no significant effects on uterine artery, umbilical artery, and MCA Doppler indices.

Effects of a levonorgestrel intrauterine system versus acopper intrauterine device on menstrual changes and uterine arteryDoppler.

To compare the effects of a levonorgestrel-releasing intrauterine system (LNG-IUS) and a copper intrauterine device (Cu-IUD) on menstrual changes and uterine artery Doppler indices. A randomized clinical trial was conducted at Menoufia University Hospital, Egypt, between December 2016 and August 2017. 306 multiparous women desiring intrauterine contraception were randomly assigned to LNG-IUS (n=152) or Cu-IUD (n=154). Uterine artery pulsatility index (PI) and resistant index (RI) were measured before use, and 3 and 6months after insertion, and associations with abnormal bleeding were evaluated. Irregular bleeding was initially reported by 31 (74%) of 42 women in the LNG-IUS group, and heavy menstrual bleeding by 53 (67%) of 79 women in the Cu-IUD group. Incidence of abnormal bleeding decreased over the 6-month study period. Uterine artery PI was significantly correlated with abnormal bleeding at a cutoff of 1.35 with area under the curve (AUC) 0.93, sensitivity 88%, and specificity 100%, whereas uterine artery RI was significantly correlated with abnormal bleeding at a cutoff of 0.62 with AUC 0.1, sensitivity 96%, and specificity 100%. LNG-IUS-related abnormal bleeding was associated with changes in uterine artery blood flow that were not evident among Cu-IUD users. Pan African Clinical Trials Registry: PACTR201701001900640.

Third trimester uterine artery Doppler indices as predictors of preeclampsia and neonatal small for gestational age

Objective: To test the hypothesis that third-trimester uterine artery Doppler (UAD) predicts adverse pregnancy and neonatal outcomes in a high-risk population.Study design: This is a nested case control study of women with singleton gestations referred for a fetal growth ultrasound between 24 and 36 weeks. Third-trimester UAD was performed if estimated fetal weight (Hadlock’s chart) was <20th percentile as these patients were considered high risk for poor pregnancy outcomes. The primary outcomes assessed were neonatal small for gestational age (SGA) and hypertensive disorders. Secondary outcomes included pH <7.10, NICU admission, Apgar <7 at 5 minutes, respiratory distress syndrome, hypoglycemia, and a composite (presence of one or more of the secondary outcomes) neonatal adverse outcome. The sensitivity and specificity of the UAD indices for predicting these outcomes were compared.Results: Among 200 women included, neonatal SGA occurred in 91 (46%) neonates, preeclampsia in 21 (10.5%), early preeclampsia in 4 (2%) and a composite adverse outcome in 67 (34%) neonates. Abnormal UAD indices, specifically left uterine artery notching and pulsatile index (PI) >95th percentile, were significantly correlated with an increased relative risk (RR) of a number of outcomes. Left uterine artery notching was significantly associated with SGA, RR 1.76 (1.03–3.04), preeclampsia, RR 2.53 (1.47–4.37) and early preeclampsia, RR 2.88 (1.34–6.20). The PI >95th percentile was significantly associated with SGA, RR 1.83 (1.21–2.76), NICU admission, RR 1.79 (1.14–2.79), preeclampsia, RR 1.98 (1.29–3.03), and early preeclampsia, RR 3.13 (2.54–3.86). The mean UAD PI >95th percentile had the best sensitivity for SGA, but the area under the ROC curve (AUC) was modest (0.60, 95% CI = 0.53–0.67). Left uterine artery notching and PI >95th percentile had similar predictive utility for preeclampsia AUC 0.65, 95% CI = 0.53–0.76 (mean uterine artery PI >95th percentile) and AUC 0.66, 95% CI = 0.54–0.77 (left uterine artery notching).Conclusion: Abnormal third-trimester UAD indices are associated with adverse perinatal outcomes including neonatal SGA, preeclampsia, and early preeclampsia. Though statistically significantly correlated, the predictive value of UAD indices for adverse pregnancy and neonatal outcomes was modest.

Uterine artery Doppler indices may predict significant causes of perimenopausal bleeding

Objective The aim was to assess whether uterine artery Doppler indices can predict significant causes of uterine bleeding in patients with perimenopausal bleeding or not. Background Treatment of abnormal uterine bleeding needs easy diagnostic procedure, for determining the etiological factor of disease. The abnormal uterine bleeding is more common in the perimenopausal than in the postmenopausal women, and it is a sign of endometrial proliferative or hyperplastic changes. Patients and methods This prospective observational study was conducted on 106 women with perimenopausal bleeding [who were subdivided into two groups, one with nonsignificant causes (52 patients) and the other with significant causes (54 patients)] and 50 healthy controls, with transvaginal ultrasonic color Doppler study performed before endometrial sampling with pipelle in those with perimenopausal bleeding. Test characteristics of uterine artery pulsatility index and resistance index for prediction of significant causes of bleeding were the main outcome measures. Results Uterine artery pulsatility index at cutoff value of 1.82 with area under the curve of 0.834, sensitivity of 70.8%, specificity of 92%, positive predictive value of 94.9%, negative predictive value of 69.9%, and accuracy of 78%, whereas uterine artery resistance index at cutoff value of 0.575 with area under the curve of. 998, sensitivity of 96.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 92.6%, and accuracy of 97% were predictive of significant causes of perimenopausal bleeding. Conclusion Uterine artery Doppler is a simple, readily available and noninvasive tool that could be beneficial in conjunction with endometrial sampling to detect significant causes of perimenopausal bleeding.

Uterine artery Doppler indices in pregnancy-induced hypertension in North Western Nigeria

Background: Pregnancy-induced hypertension (PIH) is a syndrome of hypertension with or without proteinuria, occurring when systolic blood pressure is greater than or equal to 140 mmHg and diastolic blood pressure is greater than or equal to 90 mmHg at gestational age of 20 weeks and above in a woman who has been previously normotensive. Doppler ultrasound (DUS) is now routinely used for evaluation of accessible vessels, hence its clinical application in patients with PIH. Aims and Objective: To evaluate the usefulness of DUS of the uterine artery (UA) in women with PIH. Materials and Methods: This was a prospective case–control study in which ultrasound examination of the uterus of 400 patients (200 hypertensive and 200 normotensive pregnant women) was performed. The UA Doppler indices, resistivity index, and systolic/diastolic ratio (RI and SD/DV) were recorded. Results: The mean RI in the PIH group (0.64 ± 0.07) was significantly higher than the mean of 0.50 ± 0.06 among the control group (t = 19.922, df = 398; P

The use of uterine artery doppler indices for prediction of pre-eclampsia in Port-Harcourt, Nigeria.

Pre-eclampsia (PrE), a clinical syndrome characterised by elevated blood pressure arising after 20 weeks of gestation, is a leading cause of maternal death worldwide. We evaluated the role of uterine artery Doppler (UtAD) in screening for PrE among unselected, pregnant women. This was a prospective cohort study of 170 healthy gravid women between 18 and 26 weeks of gestation recruited consecutively from the Antenatal Clinic of Braithwaite Memorial Specialist Hospital, Port-Harcourt, Nigeria, between July 2016 and June 2017. All had UtAD scans with an abnormal result defined as pulsatility index (PI), resistance index or systolic/diastolic (S/D) ratio >95th centile for gestational age or proto-diastolic notching. Outcome was obtained from antenatal records. Data were analysed using Statistical Package for Social Sciences, version 20 at statistical significance level of P < 0.05. The prevalence of PrE was 7.6%. There was significant association between an abnormal PI (χ2 = 16.29, P = 0.00), S/D ratio (χ2 = 8.55, P = 0.00) and the combined result (χ2 = 11.5, P = 0.007) with subsequent PrE. The highest sensitivity (53.8%) was obtained for the combined result with specificity, negative predictive value (NPV) and positive predictive value of 86.6%, 95.8% and 25%, respectively, area under the curve (AUC) of 0.71 (95% confidence interval [CI]: 0.534-0.871). A normal result had a very high NPV for all indices. The accuracy for the prediction of severe PrE was greater for all indices being highest for the combined result AUC of 0.830 (95% CI: 0.624-1.000; P = 0.01). Abnormal UtAD indices were associated with PrE and may be used in PrE screening.